Page 65 - PJ MED OPS Handbook 8th Ed

Fracture Hematoma Block

Indications: Pain control for fracture reduction. Commonly used for closed fractures of the distal
forearm and hand. Is relatively easy and quick to perform.

CAUTION: May cause infection of skin and fracture if overlying skin not cleaned appropri-
ately. Be sure to wait about 5 to 10 minutes after procedure before attempting reduction.

Contraindications: Do not attempt in open
fractures and do not attempt to inject visibly
soiled skin. Do not give more lidocaine if total
will exceed toxic dose (if lidocaine was used
for another procedure, be sure that cumula-
tive dose does not exceed toxic dose).

Procedure: Thoroughly clean skin over frac-
tured area to prevent infection. Can use 1%
lidocaine (5 to 15mL) or 2% lidocaine (5 to
10mL) for injection. NO EPINEPHRINE. In-
ject lidocaine with needle and syringe into
fractured area and around fractured bone.
Aspirate prior to injection to ensure that the
needle is not intravascular. The aspirate will
have blood mixed with fat/marrow, but should
not be bright red or pulsatile. Larger frac-
tures may require larger volumes of lidocaine
but keep in mind the toxic dose of lidocaine
(4.5mg/kg or max of 300mg; 30mL of 1% lido-
caine = 15mL of 2% lidocaine = 300mg). Pain
relief seen in roughly 5 to 10 minutes and will
last for 1–2 hours.

Chapter 6. Surgical and Medical Procedures n 63